S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1938
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 17, 2017
                                ___________
 
 Introduced by M. of A. JOYNER -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance law and the public health law, in relation
   to enacting the "health insurance preauthorization disclosure act"
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Short title. This act shall be known and may  be  cited  as
 the "health insurance preauthorization disclosure act".
   § 2. The insurance law is amended by adding a new section 4242 to read
 as follows:
   §  4242.  HEALTH INSURANCE COMPANIES; PREAUTHORIZATION FOR HEALTH CARE
 SERVICES. EVERY HEALTH CARE  INSURANCE  COMPANY  SHALL  BE  REQUIRED  TO
 PROVIDE  PARTICIPATING  PHYSICIANS AND HEALTH CARE PROVIDERS, AS DEFINED
 IN SUBDIVISION SEVEN OF SECTION TWENTY-NINE HUNDRED EIGHTY OF THE PUBLIC
 HEALTH LAW, WITH AN UPDATED  LIST OF HEALTH CARE TREATMENTS AND SERVICES
 THAT REQUIRE PREAUTHORIZATION OR PRECERTIFICATION FROM SUCH HEALTH  CARE
 INSURANCE COMPANY.  SUCH LIST SHALL BE DEVELOPED BASED UPON CONSULTATION
 WITH  MEDICAL  GUIDELINES  DEVELOPED  BY  THE RELEVANT MEDICAL SPECIALTY
 ORGANIZATION AND IN CONSULTATION WITH APPROPRIATELY  TRAINED  PHYSICIANS
 PRACTICING  WITHIN  THE REGION THE HEALTH CARE INSURANCE COMPANY SERVES.
 SUCH LIST SHALL BE UPDATED ANNUALLY OR MORE FREQUENTLY  AS  APPROPRIATE.
 ONLY  THOSE  HEALTH CARE SERVICES WHICH ARE CONTAINED ON SUCH LIST SHALL
 BE SUBJECT TO PRE-AUTHORIZATION OR PRECERTIFICATION BY THE  HEALTH  CARE
 INSURANCE COMPANY. NO HEALTH CARE TREATMENT OR SERVICE SHALL BE ADDED TO
 THE  LIST  OF  SERVICES  REQUIRING PRE-AUTHORIZATION OR PRECERTIFICATION
 UNLESS THE HEALTH CARE INSURANCE COMPANY PROVIDES A  MINIMUM  OF  NINETY
 DAYS NOTICE TO PARTICIPATING PHYSICIANS AND HEALTH CARE PROVIDERS.
   §  3.  The public health law is amended by adding a new section 4905-a
 to read as follows:
   § 4905-A. PRE-AUTHORIZED SERVICES. EVERY HEALTH  CARE  PLAN  SHALL  BE
 REQUIRED TO DEVELOP AND PROVIDE TO PARTICIPATING HEALTH CARE PROVIDERS A
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD06705-01-7

 A. 1938                             2
 
 LIST  OF  HEALTH CARE SERVICES THAT REQUIRE PRE-AUTHORIZATION OR PRECER-
 TIFICATION FROM SUCH HEALTH CARE PLAN.  SUCH  LIST  SHALL  BE  DEVELOPED
 BASED  UPON  CONSULTATION WITH MEDICAL GUIDELINES DEVELOPED BY THE RELE-
 VANT  MEDICAL  SPECIALTY ORGANIZATION AND IN CONSULTATION WITH APPROPRI-
 ATELY TRAINED PHYSICIANS PRACTICING WITHIN THE REGION  THE  HEALTH  CARE
 PLAN  SERVES.  SUCH LIST SHALL BE UPDATED ANNUALLY OR MORE FREQUENTLY AS
 APPROPRIATE. ONLY THOSE HEALTH CARE SERVICES WHICH ARE CONTAINED ON SUCH
 LIST SHALL BE SUBJECT TO PRE-AUTHORIZATION OR  PRECERTIFICATION  BY  THE
 HEALTH  CARE PLAN.  NO HEALTH CARE SERVICE SHALL BE ADDED TO THE LIST OF
 SERVICES REQUIRING  PRE-AUTHORIZATION  OR  PRECERTIFICATION  UNLESS  THE
 HEALTH CARE PLAN PROVIDES A MINIMUM OF NINETY DAYS NOTICE TO PARTICIPAT-
 ING HEALTH CARE PROVIDERS.
   §  4.  The  insurance law is amended by adding a new section 4905-a to
 read as follows:
   § 4905-A. PRE-AUTHORIZED SERVICES. EVERY HEALTH  CARE  PLAN  SHALL  BE
 REQUIRED TO DEVELOP AND PROVIDE TO PARTICIPATING HEALTH CARE PROVIDERS A
 LIST  OF  HEALTH CARE SERVICES THAT REQUIRE PRE-AUTHORIZATION OR PRECER-
 TIFICATION FROM SUCH HEALTH CARE PLAN.  SUCH  LIST  SHALL  BE  DEVELOPED
 BASED  UPON  CONSULTATION WITH MEDICAL GUIDELINES DEVELOPED BY THE RELE-
 VANT MEDICAL SPECIALTY ORGANIZATION AND IN CONSULTATION  WITH  APPROPRI-
 ATELY  TRAINED  PHYSICIANS  PRACTICING WITHIN THE REGION THE HEALTH CARE
 PLAN SERVES. SUCH LIST SHALL BE UPDATED ANNUALLY OR MORE  FREQUENTLY  AS
 APPROPRIATE. ONLY THOSE HEALTH CARE SERVICES WHICH ARE CONTAINED ON SUCH
 LIST  SHALL  BE  SUBJECT TO PRE-AUTHORIZATION OR PRECERTIFICATION BY THE
 HEALTH CARE PLAN.  NO HEALTH CARE SERVICE SHALL BE ADDED TO THE LIST  OF
 SERVICES  REQUIRING  PRE-AUTHORIZATION  OR  PRECERTIFICATION  UNLESS THE
 HEALTH CARE PLAN PROVIDES A MINIMUM OF NINETY DAYS NOTICE TO PARTICIPAT-
 ING HEALTH CARE PROVIDERS.
   § 5. This act shall take effect on the sixtieth  day  after  it  shall
 have  become  a law; provided, however that the superintendent of finan-
 cial services is hereby authorized to promulgate  all  rules  and  regu-
 lations  and  take any other measures necessary to implement this act on
 its effective date.